Describe the three meanings of discoloration as it pertains to embalmers.
- color is removed or lost
- to change color
- any abnormal color appearing in or on the dead human body
What are the three general types of jaundice?
toxic, hemolytic, obstructive
When embalming the jaundiced body, what factor takes precedence over all others?
This is defined as an elevation of the epidermis containing a watery liquid.
List and describe the three categories of burns.
1st: skin surface is red, only surface epithelium involved
2nd: skin blisters and edema, destruction of deep layers of epidermis and upper layers of dermis
3rd: tissues charred, epidermis, dermis and epidermal derivatives destroyed
a blush color of the skin and the mucous membranes due to insufficient oxygen in the blood
excessive blood loss to the point of death
List several different embalming treatments for a jaundiced body.
Use of jaundice fluid, pre injection fluid, mild arterial solution, cavity fluid as arterial fluid
Give a detailed description of how jaundice occurs.
the conversion of bilirubin to biliverdin in the presence of a strong acidic environment (high HCHO)
What is meant by the term "reaction controlled fluids"?
able to be distributed throughout body and diffuse into tissue spaces before chemical reaction with proteins of the body
Describe Tardieu spots
minute petechial hemorrhages caused by rupture of minute vessels as blood settles into dependent areas of organs and tissues
List some examples of extravascular blood discolorations.
ecchymosis, purpura, petechia, hematoma, postmortem stain, tardieu spots
Why should the head and shoulders of the dead human body always be elevated?
to help drain the blood from upper tissues; blood from heart could settle in the head if not elevated
How can liver mortis be an advantage to the embalmer?
the breaking and clearing of liver mortis indicates that fluid has been distributed into those tissues
In a case of renal failure/jaundice, how is ammonia formed and what is its significance to the embalmer?
urea in the blood system converted to ammonia; ammonia neutralizes formaldehyde
Define a skin lesion
any traumatic or pathological change in the structure of the skin
What is one of the major problems encountered by the embalmer in preparing a body with diabetes mellitus?
poor peripheral circulation
What are the 4 categories of skin lesions?
- unbroken skin but discolored
- skin scaling
- skin that is broken or separated from the body
- pustular or ulcerative lesions
What is meant by the term "exanthematous" or "exanthema"?
a skin eruption accompanying certain infectious diseases; or a disease such as measles or scarlet fever, accompanied by a skin eruption
What is another term for skin slip?
Describe the classic discoloration associated with carbon monoxide poisoning and its cause.
a "cherry red" color brought about by carboxyhemoglobin, a component of the blood
On a casketed body, what is a good way to detract from eye problems with may have occurred?
use of glasses
Describe the theory behind the conversion of yellow jaundice to green jaundice. Include the chemical process and compounds involved.
Oxidation reaction; the conversion of bilirubin to biliverdin in presence of strong acidic environment.
Describe how Formaldehyde gray occurs.
Failure to remove as much blood out of the body as possible, remaining blood mixes with preservative fluids and makes a dark gray color
List some examples of surface discolorations and when they should be cleared.
Blood, butadiene, adhesive tape marks, paint, tobacco bars - clean prior to injection because pores of skin are easier to clean at that time.
List four examples of pathological discolorations.
gangrene, jaundice, tumors, meningitis
What are the classic colors of dehydration?
yellow, brown, and black
What are the "warm" areas of the hands and face?
lips, cheeks, base of chin, nose, ears
What are some causes of dehydration?
injection of too much arterial solution, use of arterial solution that is too strong, continuous or concurrent daring, passage of air over the body
Why is cavity embalming important in cases of renal failure?
bleeding will often occur in gastrointestinal tract - excellent medium for bacterial growth and potential for purge
Regarding generalized edema, what are the two main objectives of the embalmer?
1) inject solution of sufficient strength and volume to counteract the secondary dilution that occurs in tissues
2) removes as much edema from tissues as possible
What is one of the leading causes of a postmortem loss of moisture?
Generally speaking, will thoroughly embalmed tissues dehydrate more or less than under-embalmed tissues?
Discuss the effect of water temperature on embalming fluid reaction.
As temperature rises: surface tension value of solution decreases, solution penetrates tissues more rapidly, chemical reactions quicker, firming occurs faster
What is another term for extreme dehydration?
abnormal accumulation of fluid in tissue spaces, body cavities, or both.
Describe Pitting Edema
condition in which interstitial spaces contain such excessive amounts of fluid that the skin remains depressed after palpation
What are three body sites where edema can be found?
Cellular edema, Intercellular edema, Edema of body cavities
What is another term for generalized edema?
List 5 types of "body cavity" edema and describe where they occur.
Ascites: abdominal (peritoneal) cavity
Hydrothorax: plural cavity
Hydrocephalus: cranial cavity
Hydropericardium: pericardial sac surrounding the heart
Hydrocele: tunica vaginalis testis of the scrotum
This type of edema does NOT respond to embalming treatments and is frequently seen in facial tissues when corticosteroids have been administered.
Cellular edema (solid edema)
In a normal 160 lbs. adult male, what percentage of body weight does total body water constitute?
Under what conditions is edema said to be established?
When there is a 10% increase in total body water
What is one simple way to maintain the proper moisture level during the embalming process?
follow dilution recommendation on label of arterial fluid
List some recommended treatments that will maintain moisture or add moisture to dehydrated bodies.
use of moderate arterial solution in large volume, slow injection, use of connection, use of humectant, use of large amounts of fluid, intermittent or alternate drainage, application of massage cream
Why should one avoid excessive massaging of the hands, neck and face on a dehydrated body?
it removes tissue moisture and arterial solution from the area
After embalming, how could done use gravity as a method of treating edema of the head, face, and neck?
place body on cot for several hours with head end fully elevated and food end fully lowered
What is the theory behind using a very large volume of a mild or average (standard) arterial solution to treat generalized edema?
washes out good portion of edema
List the 6 types of arterial solutions recommended in treating edema.
very large volume of mild/average arterial solution
very strong/astringent solution
special purpose/high index fluid designed for edema
addition of dehydrating co-injection chemicals
use of epsom salts in arterial solution
How is ascites affected by the arterial solution and blood drainage?
it is unaffected by arterial fluid and blood daring because it is located within the cavity around the visceral organs
Briefly describe how Epsom salts work on edema.
creates a hypertonic solution which sets up an osmotic gradient that draws the edema from the tissue spaces toward this concentrated salt solution in the capillaries
Describe the suggested arterial solution/technique using Epsom salts.
fill container with 1/2 gallon of cool water, add as much epsom salt as can be dissolved, add 4-6 oz of high index arterial fluid, massage downward
In what situation does the epsom salt solution work best? In what situation does it NOT work well?
works with intercellular (pitting) edema, NOT with cellular (solid) edema
How could a trocar be used to treat facial edema?
pass small needle through cribriform plate
Describe the appearance of desiccated lips and fingertips.
lips: appear black, very wrinkled and shrunken
fingers: skin becomes like parchment and turns yellow-brown
List some embalming techniques used to keep a good balance of moisture in the body?
- avoid astringent or hypotonic arterial solutions
- avoid continuous drainage
- avoid rapid injection and drainage
- delay aspiration
- cover refrigerated bodies with plastic sheeting
- avoid outdated fluids
- use disinfectants that do not dehydrate the skin
What are the 3 layers of an artery?
Intima: inner layer
Media: middle layer
Adventitia: outer layer
formation of new channels in a tissue
This term describes blood clots attached the inner wall of a blood vessel.
What is a mycotic infection?
infection caused by a fungus
What is an atheroma and how might it affect the placement of the cannula?
a patchy or nodular thickening of the intimate of an artery - incision should be made where the artery is soft, a smaller cannula should be used to avoid damage to the lumen
Describe a febrile disease and how it can affect the vascular system.
disease accompanied by elevation of body temperature - may speed decomposition, lead to dehydration, coagula, drainage difficulties and swelling of small vessels and tissues on injection
This is the term for narrowing of a blood vessel.
What should be done if not drainage occurs in a case of an aortic aneurysm?
stop injection and being multi-point injection
What other problematic condition can occur when an aortic aneurysm has been surgically repaired?
severe facial edema
This term refers to pressure on the outside of an artery or vein.
How might an embalmer treat resistance brought about by visceral weight?
above and below heart injection and daring points can be employed
This term describes hardening of the arteries
The term used to describe inflammation of a vein.
This is a disease caused by the spirochete Treponema pallidum.
List and describe the three types of arteriosclerosis.
1) inner wall hardened and thickened but lumen well defined
2) lumen reduced in size and pushed to one side of the artery
3) artery completely occluded
The term used to describe a detached blood clot.
What is ischemia?
restriction in blood supply generally resulting in damage or dysfunction of tissue
The term describing an increase in red blood cells.
The condition in which the heart cannot pump enough blood to the organs of the body.
congestive heart failure
When embalming a case of an aortic aneurysm, what would little or no drainage indicated?
loss of embalming solution into thoracic or abdominal cavity
Which artery is most likely to be affected by arteriosclerosis?
A condition caused by poor arterial circulation into an area of the body, causing death of body cells.
A condition caused by occlusion of veins draining a body area that becomes the site of bacterial infection.
A term describing the localized dilation of an artery.
What is a main embalming concern of diabetes?
poor circulation due to arteriosclerosis
Of the two types of gangrene, which type cannot be treated arterially?
List some potential complications of congestive heart failure.
blood congested in right side of heart, neck veins become engorged with blood, lips ears and fingers often cyanotic, generalized pitting edema, edema of legs/feet and ascites may be present
With regard to fluid injection, how might an embalmer avoid dislodging coagulation in the vascular system?
inject with a slow rate of flow
The term which describes an endocrine disease affecting the control of blood glucose levels.
In cases of advanced decomposition, what are one of the last "organs" to decompose?
This is the organism responsible for the formation of tissue gas and gas gangrene.
Describe subcutaneous emphysema.
dissension of the tissues beneath the skin by gas or air; an antemortem condition brought about by a surgical procedure or trauma; e.g.: CPR that breaks a rib which punctures a lung, allowing air to escape into the body cavity.
What are the five gases that are found in the dead human body and case distension?
- subcutaneous emphysema
- air from embalming apparatus
- gas gangrene
- tissue gas
- decomposition gas
the term used to describe a blister filled with serous fluid which is usually caused by tissue gas.
What are the two categories of facial trauma?
-injuries in which the skin is broken
-injuries in which the skin is not broken
List some signs of renal failure.
sallow color to the skin, excoriations on the skin from repetitive scratching due to uremic pruritus, distinct odor from increased amount of urea, ammonia, edema, etc.
The term used to define the postmortem evacuation of any substance from any external orifice of the body.
There term used to describe a severe systemic itching sensation affecting kidney dialysis patients.
What are four ways that pressure responsible for purge can develop?
gas, visceral expansion, arterial solution, ascites/hydrothorax
What two factors are needed for purge to occur?
-a substance to purge
-pressure on an organ to evacuate the material
How should the embalmer proceed when arterial solution is present in purge and drainage has stopped?
a sectional injection will need to be implemented because a major fluid loss is taking place & distribution is not happening
List three types of mycotic infections.
Aspergillosis, Phycomycosis, Histoplasmosis
List two precautions all embalmers should take when a mycotic infection is suspected.
-do not compress the abdominal or thoracic cavity
-handle bodies with gloves
-use a sporicidal arterial fluid
When positioning an obese case, why is keeping the head high important?
easier to raise vessels and helps prevent purge
This type of gas usually stops when tissues are properly embalmed.
With regard to renal failure, how much more preservative chemical than normal is needed to achieve preservation?
6x more preservative chemical
What ingredient of stomach purge can dry and discolor the skin?
Define saprophytic fungi.
obtains nourishment from dead organic material
Why is disinfection of instruments so important after treating cases of tissue gas and gas gangrene?
clostridium perfringens can be passed form one body to another via contaminated instruments
This is a fatal disease caused by contamination of a wound infection by a toxin-forming, spore-forming anaerobic bacterium.
How should the embalmer proceed if arterial solution is present in purge and drainage is occurring?
continue injecting until the preservative demand is met
In the dead human body, what two factors are responsible for decomposition?
bacteria and autolytic enzymes
How would an embalmer create a "barrier" between an extremity exhibiting tissue gas and the rest of the body?
by hypodermically injecting undiluted cavity fluid after sectional embalming is completed
Why might an embalmer raise the iliac artery to inject the leg of an obese case?
it is more superficial than the femoral artery; arteries in obese cases can be quite small
The term used to describe an agent having an affinity for metallic ions such as calcium and magnesium.
The term defined as the amount of radioactive material in which 37 million atoms disintegrate each second.
What are the two main classes of chemotherapeutic agents?
These are specialized proteins that break down other proteins.
What is the term for the treatment of disease with chemical agents and drugs?
Which organ would a nephrotoxic chemotherapeutic agent adversely affect?
kidney; cause a breakdown in kidney function
Describe how a chelating chemotherapeutic agent affects the cell membrane.
they have an affinity for metallic ions (particularly calcium and magnesium) and tend to lodge in the cell membrane, creating an impenetrable layer of calcium around the cell
With regard to embalming complications, what is the main effect of corticosteroids?
they block the cell membrane by decreasing its permeability
This is the term describing the physical wasting with loss of weight and muscle mass caused by disease.
Describe the difference between the two general classes of chemotherapeutic agents.
Cytotoxic drugs: act directly on (tumor) cells to bring about their death
Antimetabolite drugs: substitute for an essential metabolite required by (cancer) cells for growth (depriving tumor cells of nutrition)
What are the five general classes of tranquilizers and mood-altering drugs?
What are the two types of chemotherapeutic agents used to control diabetes? (Include their "market" names as well.)
List some problems caused by the use of corticosteroids.
cell membrane less permeable, fluid retention, mild to severe water logging of tissues, "protects" proteolysis enzymes, gastrointestinal ulcerations and perforations of the gut, disseminated tuberculosis
List some problems caused by antibiotics.
cotton-like circulatory blockages (fungal growth), jaundice, bleeding into the skin, poor penetration
How might an embalmer restore permeability to cell membranes affected by corticosteroids?
use of a pre injection will restore some permeability; the surface-acting chemicals (surfactants) will facilitate entry of the preservative into the cells
This is the body's main center of detoxification.
liver - the hepatic circulation system
What are two ways embalming renders proteins resistance to catalytic enzymes?
-treating the proteins so they aren't susceptible to enzymes
-rendering the enzymes inactive so they cannot act on other proteins
When re-embaling the unautopsied body, why might a multi-point injection by required?
because cavity embalming already completed disrupts the vascular system
When storing a casketed body for delayed viewing, should the casket be sealed or unsealed and why?
casket should be left unsealed because sealing the casket encourages mold growth
List some reasons for a delayed viewing.
family needs to make travel arrangements, difficulty in locating the family, remains are being shipped to a different country, family members are waiting for someone to be released from the hospital
What are two major concerns in long-term storage at a medical school?
dessication and mold
Define a common carrier.
any carrier required by law to convey passengers or freight without refusal if the approved fare or charge is paid; travels according to a set schedule
What are the three categories of shipping?
Define a private carrier.
an individual or company that transports only in particular instances and only for those whom it chooses to contract
What are some occasions in which re-embalming would be necessary?
- fluid not distributed to all areas
- too little solution was injected
- concentration of fluid was too low and preservative demand not met
- injected solution was neutralized by body chemistry
- rigor mortis was mistaken for tissue fixation
What are three major factors that affect the degree and length of preservation?
- condition of body at time of preparation
- embalming thoroughness and chemical formulations
What are some objectives accomplished by long-term preservation?
families have assurance of professionally prepared loved one and subsequent peace of mind; greater value, function and purpose of protective products surrounding the deceased
Describe the differences between an air try and a combination air tray.
Air tray: for casketed remains only the bottom is wood; side, ends and top are made of heavy-grade cardboard
Combination Air tray: wood-based container with sides, ends and inside top all made of wood with an exterior cardboard covering
List some responsibilities of a shipping funeral home.
- removal from place of death
- embalm and thoroughly preserve remains
- prepare an embalming case report
- secure necessary documents
- arrange for private or common carrier transportation
- communicate to receiving fh condition of remains and scheduled timed
Why should a casket not be completely sealed before shipment on a commercial airliner?
to allow for air pressure changes inside cargo hold of the airplane
How would a funeral director obtain the regulations required to ship a body to a foreign country?
notify local consulate of foreign country and obtain regulations
According to the text, how long might a funeral director expect the processing of international shipping to take?
5 to 14 business days
This is the term used to describe a container that is airtight and impervious to external influence; or one that is completely sealed by fusion or soldering.
What are some (generally) required documents needed for international shipping?
- certified copy of death certificate
- non-contagious disease letter
- embalmer's affidavit
- non-contraband letter
List some responsibilities of a receiving funeral home.
- avoid making promises to family about time/date of services
- cooperate with shipping funeral home in providing statistical info
- be prepared for unexpected delays
What are some embalming restrictions when shipping to Israel?
Israel does not require embalming, but if embalmed, the remains must be embalmed by the gravity method and no drainage taken